{extend name="base" /}
{block name="body"}
<link rel="stylesheet" type="text/css" href="/static/web/css/lo.css" />
<div class="register_index met-member">
    <div class="container">
        <form class="form-register met-form" method="post" action="">
            <div class="form-group met-more text-muted">
                <hr />
                <span>留下您的电话</span>
            </div>
            <div class="form-group met-form-choice">	
                <div class="row">
                    <div class="met-form-file-title col-md-3">姓名</div>
                    <div class="col-md-9">
                        <input type="text" name="xingming" class="form-control" value=""  placeholder="姓名">
                    </div>
                </div>
            </div>
            <div class="form-group met-form-choice">	
                <div class="row">
                    <div class="met-form-file-title col-md-3">电话</div>
                    <div class="col-md-9">
                        <input type="text" name="dianhua" class="form-control" value=""  placeholder="电话">
                    </div>
                </div>
            </div>
            <div class="form-group met-form-choice">	
                <div class="row">
                    <div class="met-form-file-title col-md-3">备注</div>
                    <div class="col-md-9">
                        <textarea name="beizhu" class="form-control"></textarea>
                    </div>
                </div>
            </div>
            <button class="btn btn-lg btn-primary btn-block" type="submit">提交留言</button>
            
        </form>
    </div>
</div>
{/block}